Bipolar and addicted, Patrick Kennedy embodies mental health challenges

"I had a genetic predisposition for manic depression," he said, "and at home my mother suffered from alcoholism and my father from severe post-traumatic stress," a reference to the trauma of seeing his older brothers assassinated.

Kennedy's parents divorced when he was 13, and he soon began getting counseling and experimenting with drugs. The drugs took. The counseling didn't.

"I would be alright for awhile, but then need help," he said, explaining why he ultimately had to leave public office. "I could stop self-medicating for periods of time, but could never stay stopped. I could get this delusion that I was OK because I was appearing at press conferences with important people. It makes you think you don't have a problem. Denial was enormous for me.

"The common ground from autism, to addiction, to Alzheimer's," according to Kennedy, "is that these are brain illnesses. They are physiological."

Caveats

Most mental health experts would agree, but they would insist on caveats.

"Sadly, we don't know that much about what causes these syndromes that we call illnesses," said Bob Drake, a professor of psychiatry at Dartmouth Medical School. "They are not really illnesses in the same sense that congestive heart failure, or asthma or hypertension are illnesses, where we actually know something about what is going on in the cells of the body."

Drake's concerns are shared by Tom Insel, the neuroscientist who heads the National Institute of Mental Health.

"I would say the fundamental science about the brain has really undergone a revolution over the last decade or two, and we are far ahead of where we were," Insel told NPR last summer. "But taking that information and turning that into something that's clinically useful has still been a struggle."

Not just drugs

Drake worries that uncertain diagnoses and sketchy treatments combine in an overreliance on poorly understood and poorly managed drugs.

"It is not unusual at all for us to see young people coming in on 13 medicines," Drake said. "Obviously, when someone is on 13 meds, you don't have any idea what is going on." Patients are often deadened by the side effects, Drake said. "So we gradually get them off, one and then another, and then another in order to see who's there. The symptoms are controlled because they are almost catatonic."

Drake sees old-school Freudian psychoanalysis as a failed approach, and now argues that an excessively medication-oriented paradigm has also failed. The alternative is a "biopsychosocial" approach that avoids reducing psychiatry to a search for pathogens and antidotes.

Drake points to controlled studies in Australia and the Netherlands that use a minimal treatment strategy for young people with early psychosis. "They find that after six years those on the low dose strategy are functioning much better," Drake said.

For any kind of mental illness, Drake argues, much hinges on a healthy home environment, pro-social friends, and support for functioning in school or work. "Even if it's only part-time work," he added.

"We know how to do those things," Drake said. "We don't usually pay for those things, though. We pay for hospitalizations and pharmaceuticals."

"If you talk to people in the real world about what they want, they want housing, jobs, friends. They want a therapist who will help them manage their symptoms without being overwhelmed by too much medicine and side effects."

Increasingly, best practices try to balance medications and therapy, said Dee Higley, a psychology professor at Brigham Young University who specializes in addiction.

"You can modify the brain through therapy," Higley said. "You are not fixed in a particular brain structure, even as adults." Higley is referring to an approach know as "cognitive behavioral therapy," which is producing dramatic results in treating addiction and other mental challenges.